This project focuses upon the different clinical forms of leishmanial infections in humans, immune responses to the parasite, with particular reference to cell-mediated responses and the cytokine regulation of these responses, and characteristics of the causative parasites. Ten patients were referred to NIH for suspected leishmaniasis. Six were U.S. Peace Corps volunteers or tourists, and four were military personnel who had been in the Persian Gulf region and were suspected of having visceralizing leishmaniasis. All patients treated with Pentostam (pentavalent antimony) experienced asymptomatic rises in serum amylase and lipase. A trial of topical treatment with paromomycin for atypical, nonulcerating cutaneous leishmaniasis was initiated in Honduras. This is a randomly selected, double-blind, placebo-controlled study comparing 15% paromomycin plus 10% urea in soft paraffin vs. paraffin alone as placebo. Twenty six cases were enrolled in the study in July, 1994.